HIV patients often unaware of drug resistance

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"In the early days of HIV, patients often understood the science of HIV as much as most clinicians," Dr. Howard Grossman told Reuters Health. "But once the complex drug regimens with HAART (highly active antiretroviral therapy) came out, and complicated drug resistance testing was developed," it became harder for patients to keep up with the rapid advances in the field and to understand how all of this new information affects their own treatment options.

Grossman is executive director of the American Academy of HIV Medicine in Washington DC, which commissioned the survey. Included were responses from 385 physicians who treat HIV patients and 400 adults diagnosed with HIV/AIDS.

The survey results showed that 91 percent of physicians are "extremely" or "very" concerned about HIV drug resistance, compared with 54 percent of patients living with the disease.

And while 61 percent of patients said they were knowledgeable about HIV drug resistance, 59 percent were unsure if their virus had become resistant to any drugs. Among those with resistant virus, 45 percent did not know which classes of drugs were involved.

"It took a good 10 to 15 years to develop effective antiretroviral therapy, but as drug regimens became more complicated and more side effects occurred, patient adherence became more difficult," Dr. Martin Markowitz of the Aaron Diamond AIDS Research Center in New York City said in an interview with Reuters Health.

As a result of poor patient compliance, "in 2003-2004, about one out of seven new HIV infections in major cities was resistant to the non-nucleoside reverse transcriptase inhibitors, and about one in ten were resistant to at least two classes of drugs," Markowitz added.

"As a result of drug resistance, patients' treatment options are reduced." Therefore, patient education is paramount, as is emphasis on adherence to the prescribed drugs.

Both of the physicians noted that there are a number of Internet web sites, such as aidsmed.com and thebody.com, which provide "fair, balanced information."

Because "people who are more disadvantaged are disproportionately affected by HIV; it has become harder to educate or even reach that population effectively," Markowitz said. Patient education materials therefore need to be modified so the message is clear and more understandable. "And we need to teach providers how to teach about HIV and drug resistance," he added.

There are often slip-ups among physicians as well, the survey found. Because new infection rates with HIV strains that are already resistant to some drugs have increased over time, the guidelines now recommend resistance testing for all patients before they start therapy, Markowitz noted.

While 99 percent of physicians said they test for resistance when considering a switch in a patient's therapy, only 67 percent test for resistance before antiretroviral drug treatment begins.

Grossman noted that the future is not hopeless because of emerging drug resistance. "A number of new treatments are on the horizon, including integrase inhibitors, entry inhibitors and new protease inhibitors."